Women’s Health for Family Nurse Practitioner (FNP)

What are the Tier 1 contraceptive methods?

Implant
Vasectomy
Tubal ligation
IUD

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What is the mechanism by which combined estrogen-progestin oral contraceptives (COCs) suppress ovulation?

Inhibition of GnRH
Inhibition of LH and FSH

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What should be done if a single COC pill is missed?

Take the missed pill ASAP, even if it means taking 2 at once.

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List contraindications to combined estrogen-progestin oral contraceptives (COCs).

Age ≥35 years and smoking ≥15 cigarettes per day
Multiple risk factors for CVD
Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
Venous thromboembolism and not on anti-coagulant
Ischemic heart disease, or heart valve disease
History of stroke
Current breast cancer
Severe cirrhosis
Hepatocellular adenoma or malignant hepatoma
Migraine with aura
Diabetes for >20 years or if nephropathy, retinopathy, or neuropathy is present

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What is the most common progestin-only pill (POP)?

Norethindrone

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What is the recommended action if a progestin-only pill (POP) is taken more than 3 hours off schedule?

Use back up birth control for at least 2 days.

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What is the common injectable progestin-only contraceptive?

Depot medroxyprogesterone acetate

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What is the efficacy of intrauterine devices (IUDs) in pregnancy prevention?

> 99%

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What are the contraindications for levonorgestrel-releasing IUDs?

Deformity of the uterine cavity
Active pelvic infection
Unexplained AUB
Breast cancer

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What is the normal frequency of menstruation?

Every 24 to 38 days

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Define:

Primary amenorrhea

Absence of menses by 15 years old, if individual otherwise healthy and has developed secondary sexual characteristics.

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What is the treatment for primary dysmenorrhea?

Exercise
Heat therapy
NSAIDs
Hormonal contraceptives

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What does the PALM-COEIN acronym stand for in abnormal uterine bleeding (AUB)?

Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometrial dysfunction
Iatrogenic
Not otherwise classified

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What are the two most common HPV types detected in cervical cancers?

HPV 16 and HPV 18

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What are the Rotterdam criteria for diagnosing polycystic ovarian syndrome (PCOS)?

Oligomenorrhea
Hyperandrogenism
Polycystic ovaries on US

2 out of 3 must be present for a diagnosis of PCOS.

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What is the first-line treatment for endometriosis?

NSAIDs
Hormonal contraceptives

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What are the risk factors for candida vulvovaginitis?

Diabetes
Antibiotic use
Elevated estrogen levels
Immunocompromised patients

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What is the treatment for uncomplicated candida vulvovaginitis?

Fluconazole 150 mg orally, given once or twice

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When should prenatal care be initiated?

By 10 weeks gestation

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What is the risk factor for ectopic pregnancy related to contraceptive use?

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Current IUD use

What is the first diagnostic step for a breast mass in a woman under 30 years old?

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Ultrasound (US)

Fill in the blanks:

Combined estrogen-progestin oral contraceptives suppress ovulation by inhibition of the 3 hormones ______, ______ and ______.

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GnRH, LH, FSH

True or False:

COCs can be continued until menopause if there are no contraindications.

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True

List at least two contraindications to combined oral contraceptives (COCs).

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Age ≥35 years and smoking ≥15 cigarettes per day
Multiple risk factors for CVD
History of thromboembolic disease or stroke
Uncontrolled hypertension
Breast cancer (current or history)
Migraine with aura
Liver disease or hepatic tumors
Pregnancy

What is the **grace period** for administering the progestin-only injectable, depot medroxyprogesterone acetate?

every 3 months, with a 2 week grace period

What is the **most commonly used** reversible method of birth control?

Intrauterine devices | (IUD)

What are the **two types** of IUDs?

* Copper IUD * Levonorgestrel releasing IUDs (progestin only)

# Fill in the blank: Ovulation occurs approximately \_\_\_\_\_\_ hours after the LH surge.

36 to 44

What is the **PALM-COEIN acronym** used for?

Classifying causes of abnormal uterine bleeding.

What is the **most common cause** of infertility in women?

Polycystic ovarian syndrome | (PCOS)

What is the **gold standard** for diagnosing endometriosis?

Surgical biopsy

What are the **Amsel criteria** for diagnosing bacterial vaginosis?

* Characteristic vaginal discharge * Vaginal pH >4.5 * Clue cells on microscopy * Positive whiff test ## Footnote At least 3 Amsel criteria must be present for diagnosis.

What is the **preferred treatment** for vulvovaginal candidiasis in pregnant patients?

Topical azoles

What is **Naegele’s rule** used for?

Calculating the estimated delivery date (EDD). ## Footnote The estimated delivery date is calculated by counting back three months from the LMP and then adding seven days.

List at least **two physiologic changes** during pregnancy.

* Increase in plasma volume and RBCs * Increase in cardiac output * Decrease in Systemic vascular resistance and blood pressure (early pregnancy) * Increase in Tidal volume and minute ventilation * Increase in Glomerular filtration rate (GFR) * Increase in Coagulability (hypercoagulable state) * Decrease in Gastrointestinal motility

What is the **treatment** for preeclampsia?

Delivery of the placenta and fetus

What is the **presentation** of placenta previa?

Bright red vaginal bleeding from the placenta attaching too low, covering the cervix.

What is the **primary treatment** for placenta abruptio?

Emergent referral to labor & delivery

What is the **risk factor** for ectopic pregnancy?

Current IUD use or history of pelvic inflammatory disease

What is the **clinical diagnosis** for menopause?

12 months of amenorrhea, not attributed to another cause

What are the **advanced symptoms** of breast cancer?

* Peau d'orange * Axillary adenopathy

In patients under 30 years old with a breast mass, what is the next step if the mass cannot be visualized on ultrasound and clinical suspicion for cancer is low?

Observation may be appropriate.

What is the **recommended imaging approach** for a breast mass in patients aged 30 to 39 years old?

US or mammography ## Footnote US may be preferred due to high sensitivity, but if US is negative, mammography is indicated.

For patients over 40 years old with a breast mass, what is the **initial imaging modality**?

Mammography ## Footnote If a suspicious abnormality is detected, biopsy is indicated.

# Fill in the blank: Cervical cancer is the \_\_\_\_\_\_ most common cancer in the US.

3rd

What is the **typical presentation** of cervical cancer?

Often asymptomatic ## Footnote If symptoms are present, they may include abnormal vaginal bleeding and vaginal discharge.

At what **age** does **cervical cancer screening** begin, regardless of sexual activity?

21 years of age

How **often** is cervical cancer screening **recommended** after it begins at age 21?

Every 3 years

Women’s Health Flashcards

Deliver evidence-based care for women’s health issues including reproductive, gynecologic, and menopausal concerns. (48 cards)